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The CEO of Alberta’s 10-year-old health organization came to Saskatchewan to extend a hand to physicians here who are just starting to understand and work with the new Saskatchewan Health Authority (SHA).

Dr. Yiu was speaking 11 months after the formation of the SHA on Dec. 4, 2017. The theme of her address was on lessons learned from a physician leader’s perspective on Alberta’s amalgamation of health services, which got off to a rocky start.

Alberta’s move to a single health entity was sprung on the province from out of the blue, she said. All sectors came under the Alberta Health Services umbrella, and there was plenty of turmoil – including eight CEOs coming and going in eight years.

In contrast, Dr. Yiu said it appeared the SHA was taking a slow, strategic approach toward amalgamation, as some entities are continuing to function outside the authority.

She presented delegates with her list of Alberta Health Services’ top-10 accomplishments during its 10 years of existence.

One was the establishment of consistent bylaws, which took three years. She said physicians should have been engaged more at the outset, but a dyad leadership model – pairing a physician leader with a health executive – was implemented throughout the organization and turned out to be a success. The SHA has established a similar dyad leadership model.

She said Alberta’s health benchmarks lead the country in many categories, all the while saving millions of dollars by spending wisely and finding savings in the system that did not jeopardize patient safety.

“We would not have been able to do that without physician involvement at the table,” Dr. Yiu said.

President’s address

In his address to the RA, SMA president Dr. Siva Karanukaran noted the physician leadership component of the SHA. Physicians didn’t always have that voice at the senior levels of administration.

“We are more like the Superman to the Batman. We used to be like the Robin to the Batman,” he said to applause. He said the SMA will provide support to physicians who step into leadership roles.

Dr. Karunakaran touched on several themes that have emerged during his tenure and that he heard during the recently concluded President and Vice-President’s Tour of the province – including physician wellness.

Physicians have all witnessed angry, spiteful behaviour from colleagues – which were chalked up to that person having a bad day – or have seen kind, compassionate physicians simply give up, he said. Many have seen signs of impairment in their fellow doctors.

Physicians have felt helpless in the past, but Dr. Karunakaran pointed out many have sought help from the SMA’s Physician Health Program, which creates a safe place for physicians to receive the treatment they need.

Dr. Karunakaran also told delegates he sees value in maintaining mandatory joint membership in the Canadian Medical Association and the SMA. It is important for a smaller provincial medical association to be able to tap the resources of the CMA when needed, such as lobbying on national issues like federal tax changes or a pharmacare program, he said.

He also noted the issue of pharmacists’ expanded scope of care is a by-product of a lack of access to primary care. He said there is a need to make family medicine attractive for physicians already practising and for medical grads by looking at other models of care.

“We believe that every person in Saskatchewan should have a family physician and a medical home,” he said.

Minister of Health address

Health Minister Jim Reiter also noted the dyad leadership structure of the SHA during his address to the assembly on Friday, Nov. 2. He said the model ensures decisions that are made have a medical perspective.

He said the government is aware of ongoing pressures faced by physicians, including wait times to see psychologists, especially children, and patient access to specialists. He asked physicians to be patient as the ministry is working with the SMA on solutions.

The government is committed to balancing the budget by 2020, and will focus on delivering services in new and innovative ways. He pointed to team-based care models, reducing reliance on acute and emergency care, and accountable care units, which help patients come home from hospital sooner rather than rely on the health system.

Minister Reiter told delegates the government is trying to change the way mental health crises are handled in Saskatchewan. A combined $11.4 million in federal and provincial money has been invested in the area of mental health, such as in a police and crisis team launched in Prince Albert.

International Physician Health Conference

Brenda Senger, director of the SMA’s Physician Health Program, and Marcel Nobert, director, Physician Services and Benefits for the SMA, facilitated a panel of physicians who attended the International Physician Health Conference. The conference was a gathering of the Canadian Medical Association and its counterparts in the United States and the United Kingdom.

The conference, which attracted a large contingent from Saskatchewan, focused on a shift away from personal responsibility to systemic issues, she said. Personal resilience is not enough to ensure a healthy workplace for physicians.

Dr. Allan Woo, vice-president of the SMA and a panellist during the session, said a caregiver’s suffering can manifest itself without warning at any time. Dr. Woo, an orthopedic surgeon, spoke of his role during the night of the Humboldt Broncos bus crash in April, saying he and other health workers had to care for the patients in a moment of intense stress, but the effects still linger. He said he learned at the international conference that high-performing health systems make efforts to help their physicians right away when they need it.

Dr. Andriyka Papish, a psychiatrist who was on the panel, noted physician suicide is an international health crisis. She said most physicians who commit suicide don’t reach out for help – many never get a basic assessment in mental health. She said physicians must change the culture in which they work. They should be aware if they are contributing to problems in their workplace through a negative attitude, and if so, change their behavior to make kindness and wellness the norm.

Resilience and workplace mental health

Resilience is like a muscle – it’s something people can strengthen by repeatedly working on it and training it, Vancouver psychologist Marie-Helene Pelletier told RA delegates on Friday, Nov. 2.

Many people think they have resilience, but in fact do not because they have failed to put in the required training. People might appear strong and resilient, but break down when they are without the safety nets that usually protect them, she said.

Even organizations where resilience is strong see people burn out. The cost to business and the economy for lost time and work claims is enormous, she said.

The warning signs for individuals include sleep challenges, irritability, lack of concentration, difficulty making decisions, sadness and worry, alcohol abuse and use of medications or drugs. People just aren’t their normal selves, Pelletier said.

She presented five lifestyle changes people can consider making, but cautioned her audience that to make a change means doing something different in one area at the expense of doing something else, which could be part of an everyday routine. She also showed four organizational approaches a workplace can use to promote resilience.

In conclusion, she urged delegates to incorporate one change – no matter how small –in their everyday lives based on the lists she presented, and to see that change through.

SMA-CMA relationship: A panel discussion on the evolving relationship between the CMA-SMA

Two officials with the CMA participated in a panel on Saturday, Nov. 3, to discuss the relationship between the national organization and the SMA.

Dr. Sandy Buchman, president-elect of the CMA, and Owen Adams, chief policy advisor of the CMA, were joined by Dr. Karunakaran and Dr. Guruswamy Sridhar, the SMA’s representative on the CMA board.

Most of the allotted time was spent in a question and answer session, but in introducing the session Dr. Karunakaran told delegates he thought there was value in continuing the relationship. He said physicians in Canada need a strong voice at the national level, especially when it comes to lobbying Ottawa over issues such as income tax changes and MAID.

Dr. Karunakaran said the SMA has relied heavily on the research capabilities and resources of the CMA. Provincial medical associations don’t have the contacts and resources to match the CMA.

Dr. Buchman noted the CMA has a long, proud history with the SMA, which he believes will grow into the future.

Proceeds from the sale of MD Financial Management by the CMA to Scotiabank has presented a transformative opportunity for the CMA and has given it the resources to target and address key areas of concern for physicians.

MD Financial Management was sold so that the CMA could better focus on its core mandate to support physicians, Dr. Buchman said. In the future the CMA will seek grassroots input from physicians on how to use money from the sale to have the greatest impact.

Delegates to the RA debated a number of resolutions, which will be presented to the SMA Board of Directors. On Saturday morning, two in-camera sessions were held. One was an update on the SHA bylaws and rules review and the other was on negotiations with the provincial government.

The next Representative Assembly will be May 3-4, 2019, at the Sheraton Cavalier in Saskatoon.